Chronic Inflammatory Dermatoses Flashcards
What are the five chronic inflammatory dermatoses we discussed?
- psoriasis
- lichen planus
- systemic lupus erythematosis
- seborrheic dermatitis
- acne vulagris
About psoriasis…
- what’s the prevalence?
- During what generations does it peak?
- What is the genetics behind it?
- about 4%
- 30s and 60a
- presumed autosomal dominance with modifying features and environmental triggers
What are the clinical features of psoriasis?
sharply demarcated erythema usually with a thick micaceous scale
Auspitz sign (you scratch and it bleeds under the surface)
Koebner sign (happens in areas that had previous trauma)
Nail disease is common in up to 50%
Rarely pustular
What is the pathogenesis of psoriasis?
A T-CELL MEDIATED AUTOIMMUNE DISORDER
- envrionmental factor triggers T cells to produce cytokines
- The cytokines stimulate keratinocye proliferation and the production of antigenic adhesion molecules in the dermal blood vessles
- The adhesion molecules further stimulate T cells to produce cytokines
- cycles until you get the rash
What are 5 risk factors associated with psoriasis?
- genetics
- psychological stress
- medications
- infection
- chronic HIV
What are some precipitating agents of psoriasis outbreaks?
infection, trauma, stress, ETOH, systemic steroids (esp on withdrawal), beta blockers, lithium, antimalarials, Indomethacin
What should be in your diagnosis when you see psoriasis. How woul dyou tell for sure?
DD: lichem simplex chronicus, nummular eczema, seborrheic dermatitis, and tinea corporis
You have to use a punch biopsy to be sure.
What are the four types of psoriasis?
- chronic plaque (most common)
- inverse
- guttate
- pustular
Where does the chronic plaque psoriasis occur on the body?
scalp
extensor surfaces like elbow, knees, presacral and nails
palms and soles (esp thick scale of the arch of the foot and thenar hypothenar palms)
Where does inverse psoriasis usually occur on the body?
the intertriginous areas (fold areas) like the gluteal fold, axillae, and glans of the penis
What characteristic of plaque psoriasis is lackin gin inverse psoriasis?
the scale may not appear in the inverse
WHat are the chraacteristics of guttate psoriasis?
eruptive trunkal dermatosis
it’s a sudden onset of tear drop shaped (2 to 5 mm) scaled spots of the tunk and proximal extremities
When does guttate psoriasis almost always occur?
usually childhoold or young adulthoods POST STREP INFECTION
Describe pustular psoriasis?
It starts as small pustules on the palms and soles (pustular psoriasis of barber)
they generalize with fever and can be life threatening
What are complications of psoriasis?
- mental health issues - depression, anxiety, etc.
- increased risk of non-melanoma skin cancers and lmphoma
- psoriatic arthritis
WHat are two nail deformities that are associated with psoriasis?
onycolysis - the separation of the nail plate from the nail bed
pitting of the nail plate itself
In general, what is lichen planus?
a chronic inflammatory autoimmune disease
What is the prevalence of lichen planus and who does it usually effect?
.1 to 4 % of the pop
usually perimenopausal females (30-60)
What virus is lichen planus associated with?
Hep C
Where do lichen planus rashes usually occur?
WRISTS, chins, mucous membranes
What is the clinical hallmark of lichen planus?
Wickham’s striae = whitish lines visible in the stria of papeuls of lichen planus
What are the “6 Ps” of lichen planus?
planar (flat topped)
purple
polygonal (not round)
pruritic
papules
plaque
What are the 6 forms of lichen planus?
linear (classic)
annular
atrophic
jypertrophic
vesiculbullous
erosive/ilcerative
What happens in hypertrophic lichen planus?
you get very thick plaques of scale of the lichen planus, esp over the extremities and extensor surfaces
